Surgical devices assembled using heat bondable materials

ABSTRACT

Surgical devices such as implants or suture fastenings are assembled from a plurality of discrete components, one of which components includes a heat bondable material for bonding the components together. At least two components are bonded to each other by the applying heat to the heat bondable material of one component to make it bond to the other component. The heat bondable material is preferably a polymeric or composite material suitable for surgical applications and implantation in humans, and may be a biodegradable material. A laser may be used as the heat source. The present invention is advantageously embodied in heat bonded fastenings for sutures or K-wires, in which a variety of different suture anchors are usable, including expandable distal suture anchors. Other embodiments include a metal bone plate which is held to bone by a metal bone screw and a nut of bondable material bonded to the plate to secure the connection; a piece of bondable material bonded to a metal prosthesis to custom fit the prosthesis; and a surgical implant custom formed by bonding together a plurality of discrete elements one or more of which is bondable.

BACKGROUND OF THE INVENTION

1. Technical Field

The present invention relates to surgical devices such as implants orsuture fastenings which are assembled from a plurality of discretecomponents, one of which components includes a heat bondable materialfor adhering the components together.

2. Description of the Prior Art

Mundell U.S. Pat. No. 4,506,681 shows the use of a prosthesis whichincludes a biodegradable thermoplastic material molded around electricresistance elements to allow for heating to soften to mold to aparticular shape.

Polonsky U.S. Pat. No. 4,662,068 discloses cutting off most of theprotruding ends of a plastic suture and heating them to secure the endstogether.

Jacobs U.S. Pat. No. 4,750,492 shows crimping or clipping abiodegradable fastener or retainer on the end of a biodegradable suture.

The compound methyl methacrylate is an acrylic resin monomer which issometimes used in surgery to fasten or grout implants of metal to bone,or hip or knee replacements to bone. It is usable only for bone to metalapplications. Tissue reacts to it and in soft tissue it creates afibrous scar. Further, it is not biodegradable.

SUMMARY OF THE INVENTION

The present invention is an assembly for use in surgical applications inhumans. The assembly includes two components, at least one of whichcomprises a heat bondable material. The first and second components arebond to each other by the application of heat to the heat bondablematerial, to make the heat bondable material soften, become tacky, andbond to the other component.

If only one of the components comprises a heat bondable material, theapplication of heat to the heat bondable material of that componentcauses the heat bondable material to soften and bond to the othercomponent.

If both of the components comprise a heat bondable material, theapplication of heat to the heat bondable material of the componentscauses the heat bondable material of at least one and preferably eachcomponent to soften and bond to the other component.

The assembly can also include a first component, a second component, anda third component separate from the first and second components andcomprising a heat bondable material. The application of heat to the heatbondable material of the third component causes the heat bondablematerial to soften and bond to the first and second components tointerconnect the first and second components.

The heat bondable material is preferably a polymeric or compositematerial suitable for surgical applications and implantations in humans,and may be a biodegradable material where such is called for by theapplication.

The present invention is advantageously embodied in heat bondedfastenings for sutures or K-wires, in which a variety of differentsuture anchors are usable, including expandable distal suture anchors.Such suture fastenings are easier to form and stronger than conventionaltied knots. Other examples of assemblies embodying the present inventioninclude a metal bone plate which is held to bone by a metal bone screwand a nut of bondable material bonded to the plate to secure theconnection; a wedge of bondable material bonded to a metal prosthesis tocustom fit the prosthesis; and a surgical implant custom formed bybonding together a plurality of discrete elements one or more of whichis bondable. Such embodiments are further described below.

BRIEF DESCRIPTION OF THE DRAWINGS

Further features of the present invention will become apparent to thoseskilled in the art to which the present invention relates from readingthe following specification with reference to the accompanying drawings,in which:

FIG. 1 is an illustration of a metal bone plate which is held to bone bya metal bone screw and a nut of bondable material bonded to the plate tosecure the connection in accordance with the present invention;

FIG. 1A is an illustration of a bone plate of bondable material which isheld to bone by a bone screw and nut both of bondable material andbonded to each other to secure the connection;

FIG. 2 illustrates the use of a bonded fastening in accordance with thepresent invention to obtain increased holding power on a fastenerextending through a bone;

FIG. 3 is an illustration of a wedge of bondable material bonded to ametal hip prosthesis to custom fit the prosthesis;

FIGS. 4A and 4B are illustrations of a wedge of bondable material bondedto a metal tibial prosthesis to custom fit the prosthesis;

FIG. 5 is an illustration of a surgical implant custom formed by bondingtogether a plurality of discrete bondable elements;

FIG. 6 is an illustration of the use of a third component of bondablematerial to custom form a surgical implant by bonding together aplurality of discrete elements;

FIGS. 7A thru 7C are illustrations of a bonded suture fastening inaccordance with the present invention;

FIGS. 8A thru 8I are schematic illustrations of a variety of differentsuture anchors usable in bonded suture fastenings;

FIGS. 9A thru 9D are illustrations of an expandable distal suture anchorusable in bonded suture fastenings;

FIG. 10 illustrates the use of a curved hole in tissue parts to bejoined with bonded fastenings on either end of the joining element; and

FIGS. 11A thru 11C are illustrations of a bonded rivet in accordancewith the present invention.

DESCRIPTION OF PREFERRED EMBODIMENTS

In this application, the term "bondable" or "bondable material" is usedto refer to any material, suitable for use in surgical applications,which can be softened and made flowable by the application of heat, andwhich, when softened, will become tacky and bond to other materials andwill flow to fill available space. Thus, the material is thermoplastic,but it must also exhibit tackiness or bonding ability when in itsplastic form. Many materials suitable for surgery are made of orincorporate such heat bondable materials. Many biodegradables, polymerssuch as polyethylene, and composites fall in this class. They can bejoined by heat bonding at reasonably low temperatures which can beapplied in the operating room safely, unlike the very high temperaturestend to melt metal. Composite materials can include reinforced plastics,or polymers which are laminated or layered or reinforced with one ormore other materials such as nylon, graphite fibers, Kevlar® fibers,stainless steel fibers, etc. Many sutures are made of polymers which aresuitable for use herein. Selection of such material is within theordinary skill of the art.

Any suitable heat generating apparatus can be used to heat and soften orspot weld the material, such as a hot air gun, a small welding orsoldering gun, or a Bovie tip. Also usable are lasers, which arecommonly provided in operating rooms. Lasers are especially desirablebecause they are precise and controlled in their application cangenerate sufficient heat very quickly, and cause less thermal necrosisbecause there is less misdirected heat. The heating operation can bedone pre-operatively to form an assembly; can be done outside the bodybut in the operating room to customize implants at the time of surgery;or can be done during surgery, in the body, when the bond is neededwithin the human body.

FIRST EMBODIMENT

FIGS. 1 and 2 illustrate heat bonded assemblies including existingsurgical objects such as plates, screws, etc. In FIG. 1, a bone plate 10is secured to bone material 12 by a bone screw 14. The bone plate 10 andthe bone screw 14 are both made of metal. Ordinarily, the bone screw 14would be secured to the bone plate 10 by a metal nut threaded onto thebone screw 14 and run up adjacent the bone plate 10. However, such aconnection can loosen and thus destroy the integrity of the assembly.Accordingly, in accordance with the present invention, a nut 16 isprovided which is made of or includes a bondable material. The nut 16 isthreaded on the bone screw 14 into abutting engagement with the boneplate 10. Then, the bondable material of the nut 16 is heated andsoftened to flow about the joint between the nut 16 and the bone plate10, to bond the nut 16 to the bone plate 10. The nut 16 can also be bondto the bone screw 14 if desired for a stronger connection.

FIG. 1A illustrates an assembly similar to FIG. 1 in which a bone plate18 and a bone screw 20 both made of or including bondable material areprovided. The nut 16 (FIG. 1) is not used. Instead, the bone screw 20 isbonded directly to the bone plate 18 at an area 22.

As noted, ordinarily a bone plate is held to bone via a threadedfastener such as the bone screw 14 or 20 in FIG. 1. However, the bone isalive and is constantly remodeling the threads on the bone screw. Asthis happens, the fastener loses its purchase or holding power in thebone, and the screw can pull loose. Accordingly, it would be desirableto obtain more purchase by a different kind of fastener.

FIG. 2 illustrates the use of a bonded fastening in accordance with thepresent invention to obtain increased holding power. The fastenerextends completely through a tissue mass such as a bone 160, for exampleto secure a plate in position against the bone. An elongate fastener162, which may be metal or may be made of or include a bondablematerial, is inserted through an opening in the bone 160. A distalfastener 164 is secured to the distal end of the screw 162 by a plug ofbonded material 166. The plate 168 is then placed over the bone screw,and a proximal fastener 170 made of or including a bondable material isbonded to either or both of the screw 162 and the plate 168. Theelongate fastener 162 may optionally also be threaded in the portionengaging the bone 160. The elongate fastener 162 may optionally also bethreaded in the portion engaging the fastener 164 and/or the fastener170.

The bonded fastenings obtained thereby are stronger than is possiblewith either a threaded connection or a tied or crimped connection.Further, there is no reliance on a threaded connection between bone andfastener which will inevitably weaken over time. Also, bone screws arethreaded and ar always straight. The elongate fastener 162 need not bestraight because it need not be threaded. Thus, it can be curved, orangled, as needed or desired to fit any particular application. Incombination with the bonded connection of the fasteners at the ends ofthe elongate fastener, such a structure is a vast improvement over atypical metal threaded fastener.

FIGS. 3 and 4 illustrate surgical assemblies in which an existingsurgical prosthesis or implant has been modified to better fit theparticular application. Such prostheses or implants come from amanufacturer in only a limited range of sizes and shapes. However, theparticular bone into which a prosthesis or implant is to be inserted mayhave defects or size discrepancies which would make it impossible toobtain a good fit with even the closest fitting prosthesis or implant.

In accordance with the present invention, the shape and size of aprosthesis or implant are modified to fit a particular bone. A femoralprosthesis 30 illustrated in FIG. 3 has been modified with the additionof a wedge 32 including heat bondable material in order to better fit agap 34 in the bone 36. The wedge 32 is custom shaped to fit the gap 34exactly. The connection 38 between the wedge 32 and the prosthesis 30 issecured by heating and softening the wedge 32 so that the material ofthe wedge 32 adheres or bonds to the prosthesis 30. The assembly of theheat bondable wedge 32 and the femoral prosthesis 30 fits the femur 36much more properly than would the prosthesis alone. This assembly caneasily be made right in the operating room at the time of the jointreduction, allowing the surgeon to customize or equilibrate at the timeof surgery.

Similarly, in FIG. 4, a tibia 40 is shown to have an area of defect 42which makes it impossible to properly fit a tibial component 44.Accordingly, as seen in FIG. 4B, an element 46 including a heat bondablematerial is shaped with heat as by a laser in the operating room to fitthe defect 42. The element 46 is then bonded to the tibial component 44prior to placement thereof in the bone 40. The assembly of the tibialcomponent 40 and the element 46 provides a proper fit in the tibia 40.There is no other suitable way of matching the requirements of bone andjoint in the operating room.

The bone components shown in FIGS. 3 and 4 are only an illustration ofthe many kinds of objects which can be used to form assemblies embodyingthe present invention. It can thus be seen, as illustrated in FIGS. 3and 4, that the present invention gives the surgeon the ability toimmediately modify the shape and size of almost any existing surgicalpart including a prosthesis, in order to better fit the particularapplication for use in the body. This is accomplished by heat bonding apiece of bondable material onto the prosthesis, to make an assemblydesigned for the particular application. The piece can be custom shapedin the operating room to fit the application exactly by heating andbonding of a polymer or composite.

FIGS. 5 and 6 illustrate schematically some custom fabricated implantswhich can be constructed in accordance with the present invention. InFIG. 5, a relatively thick plate 50 is joined to a relatively thin plate52. Both the plate 50 and the plate 52 are made of or include a bondablematerial. The plates 50 and 52 are joined at the area of the joint 54between them, by bonding in accordance with the present invention. Athird element such as a stud 56 may be added, with bonding at the joint58 therebetween. Thus, the surgeon has the ability to laminate pieces insurgery and does not have to rely on pre-made hardware.

It should be understood that the illustration in FIG. 5 of plates and astud is not limiting, but is only illustrative of the almost limitlessnumber of surgical devices which can be constructed in accordance withthe present invention. Items such as rods, bars, plates, or any type ofconstruct usable in medical/surgical applications object can be customshaped or built up in accordance with the present invention. They can bemade of polymers or composites which can easily be cut with a laser andalso softened to custom fit. They can be made of or include abiodegradable material in those instances where it is desired that thematerial be replaced, over time, with natural tissue ingrowth. They canalso include tissue ingrowth promoters, antibiotics, or other additivesas desired.

Rather than having one or both of the components to be joined made of abondable material, a third component can be used to join them, with thethird component being made of or including a heat bondable material. Thethird component is non-flowable and non-adherent at room temperaturebefore use. When it is softened by heating and applied to the first andsecond components, it bonds to both components to interconnect them. Alaser is ideal for heating the interpositional bonding material becauseof the accuracy available with the laser. As an example, FIG. 6illustrates an assembly similar to FIG. 5 in which a plate 60 and aplate 62 and a stud 64 are joined by the use of additional bondingmaterial at locations 66, 68, 70, and 72. In this case, the plates 60and 62 and the stud 64 need not be made of heat bondable materials.

For example, a total hip or knee replacement is possible usingcomponents bonded together by heat. If some or all of the parts are madeof heat bondable material such as polymers or composites, an assembly asdescribed herein can be produced simply by the application of heat tobond the parts together as desired. If the replacement does not fit theexisting bone exactly, it can be customized at the time of surgery bycutting as with a laser, by adding as by bonding, or by heating to bondwedges or pieces to it.

It can be seen that the present invention also provides the capabilityfor forming a custom-fit surgical implant for bonding to a bone or to abone prosthesis which comprises a component at least partially formed ofa heat-bondable material which has been custom-shaped by the applicationof heat to said heat-bondable material. In this instance, theaforementioned laser is most suitable for forming the implant. Thelasers which are commonly found in operating rooms can cut, shape, andotherwise form almost any suitable material used herein, includingpolymers, biodegradable materials, and even composites includingreinforcing materials. The implant can include several components eachhaving heat-bondable material, or several components only one of whichincludes a heat-bondable material, or it can be a single component whichis custom made for a particular application. Such use of heat to formimplants provides the surgeon with greatly extended capabilities in theoperating room and does not limit him to pre-formed implants orprostheses.

SECOND EMBODIMENT

It is difficult to tie a suture knot to itself or to slide it downthrough deep tissue in a limited working area (as in fiber opticsurgery). Typically, the surgeon can often not work in a straight linebut needs to use a suture loop (going through the tissue twice) to bringtissue together. Any such increase in the amount of tissue through whichthe suture must pass increases damage to tissue. Furthermore, mechanicaltying or crimping of sutures or K-wires, especially of polymers orbiodegradables which are generally smooth, does not produce connectionswhich are as strong as desirable, and suture connections sometimes maycome untied as a result.

In accordance with the present invention, surgical connections forholding adjoining tissues together are secured by melting a fastener oranchor on the end of a suture, rather than by tying or by clipping theanchor on the end of the suture. (The term "suture" is used herein torefer to a suture, a K-wire, or any similar surgical connector.) Theanchor is pushed over the free end of the suture down to the tissue,drawing the tissues together. Either the anchor alone or the anchor andthe suture are melted together to lock them into position.

With the fasteners of the present invention, therefore, a surgeon hasmore control since he can apply more pressure to push the tissuestogether and it is easier to appose the tissues; the tension on therepaired tissues is more controllable, predictable, and reproducible;and the fasteners can be used in a smaller working space. Further, amelted anchor provides a stronger bond than the mechanical interlock ofa suture knot, because it will not unravel or come apart as a surgicalknot may. It takes less time to fasten than it does to tie a suitableknot. There is improved contact between the tissues being joined becauseof the better suture connection. The straight line suture fastening alsoavoids buckling of the tissue edges caused by force vectors notextending in the direction of the suture.

Since he only needs one free suture end to make a secure connection, thesurgeon does not need to use a suture loop to bring tissue together, butcan work in a straight line. This lessens damage to tissue because astraight line connection is easier to obtain than a loop in a limitedspace. Also, it improves tissue apposition and approximation when astraight line fastening is pulled together rather than a loop whichtends to buckle or pucker tissue at the edges because of the forcevectors not directed along the length of the suture.

The fasteners can be used for the fixation of soft tissue, tendon,ligament, meniscus, muscle, fascia, vessels, nerves or bones to eachother. They can be used, for example, to hold a rotator cuff to bone, orto join fracture fragments of bone to bone. The anchors can be custommolded, specially made at the time of surgery (or preoperatively) toconform exactly to the tissue or bone application.

One anchor is secured to the distal end of the suture. (Alternatively,it may be preformed or connected on the suture in any known manner ofconnection.) The suture is then positioned in the tissues to be joined,a second anchor is slid over the free end, pulled down to close the gap,and melt it in place.

As illustrated in FIG. 7, two pieces of tissue 80 and 82 are to bejoined using a suture 84. A distal anchor 86 is located on the end ofthe suture 84. The suture is then inserted through the tissues 82 and 80so that a free end 88 of the suture 84 protrudes at the proximal end. Afastener 90 having an opening 92 therein is slid over the wire 84 andpulled down tight as shown in FIG. 7C to close the gap 94 between thetissues 80 and 82.

The fastener 90 is made of a heat bondable material. (The suture canalso be made of heat bondable material which is bonded to secure theconnection.) The fastener 90 is then bonded at an area 96 to theprotruding free end 88 of the suture 84. Alternatively, the fastener 90can be bonded along the length of the opening 92 to the suture 84. Theprotruding end of the suture 84 is then cut off. Applicant has foundthrough testing that while a simple mechanical connection such as a knotor a crimped connector is not strong enough to hold in somecircumstances, the bonded connection illustrated in FIG. 7 overcomesthis difficulty and will hold.

FIG. 8 illustrates a few of the many fasteners which can be used inaccordance with the present invention. FIG. 8A shows a simple squarefastener 100 having a suture receiving opening 102 therein. The fastener104 is round and has an opening 106 therein. The fastener 108 shown inFIG. 8C includes a plurality of barbs 110 for better gripping in thetissue against which it engages. The fastener 112 shown in FIG. 8 isumbrella-like in shape, having an outer rib 114 and a plurality ofradially extending ribs 116.

The fastener 118 shown in FIG. 8E is filamentous, having a plurality ofprotruding filaments 120. The fastener 122 shown in FIG. 8F is a T-snap.The fastener 124 shown in FIG. 8G is curved or cupped about the opening126 so that its ends 128 and 130 will flatten as pressure is appliedupon drawing tight the suture. The fastener 132 shown in FIGS. 8H and 8Iis reinforced with transverse ribs 134 and longitudinal ribs 136 forbetter strength. The ribs 134 and 136 protrude axially from the mainbody 138 of the fastener. Finally, any anchor or fastener can bespecially made, that is, custom molded at the time of the surgery orpreoperatively to conform exactly to the tissue against which it will beabutting.

FIG. 9 illustrates the use of an expandable distal suture anchor forbonded suture fastenings in accordance with the present invention. Inparticular, FIG. 9 illustrates the use of a bonded assembly to secure atendon 140 to bone 142. To make the assembly, initially, a cannula orsleeve 144 is inserted through the tendon to the bone. A gouge 146 isthen used to gouge out an opening 148 in the soft cancellous tissueunder the cortical bone. An expandable anchor 150, confined in a sleeve152 and having a suture 154 extending proximally from the sleeve 152, isinserted through the canula 144 into the opening 148 in the bone. Thesleeve 152 is then withdrawn, allowing the anchor 150 to expand withinthe opening 148, blocking removal of the suture.

A fastener 156 made of or including a bondable material is then sliddistally over the suture 154 into engagement with the tendon 140, andthen further, pushing the tendon 140 into engagement with the bone 142.The anchor 156 is then bonded to the suture 154, providing a connectionwhich is stronger than that of any tied knot. In a similar manner, anexpandable anchor as illustrated herein can be used with a bondedfastening in any application in which the anchor must be placed in ablind location. This method can work also especially well with a barbedor umbrella-like anchor as illustrated in FIGS. 8C or 8D.

FIG. 10 illustrates, the use of bonded fastenings in accordance with thepresent invention in conjunction with a curved opening in tissue partsto be joined. Illustrated in FIG. 10 are two portions 172 and 174 of afractured bone with their ends abutting at a joint 176. It is possibleto secure together the bone ends with a suture which extends axiallythrough the fractured ends of the bone, while accessing the joint onlyfrom one side of the bone. A curved opening 178 is drilled through thefirst bone part 172 and the second bone part 174, beginning at theproximal end of the first bone part 172, extending through the joint176, and exiting at the proximal face of the second bone part 174. Asuture 180 is then passed through the opening 178. A first fastener 182made of or including a bondable material is then bonded onto theprotruding end of the suture 180. The suture is then pulled tight, and asecond fastener 184 also made of or including a bondable material ispulled down tight against the proximal face of the second bone part 174and bonded by heating in location to the suture 180.

FIG. 11 illustrates the use of a bonded fastening in accordance with thepresent invention in conjunction with a rivet type fastening. To securetogether two adjoining masses 186 and 188, a sleeve 190 is insertedthrough an opening in the tissues until the distal end 192 of the sleeveprojects behind the tissue 186. A mandrel 194 in the sleeve 190 has aheaded portion 196 at its distal end 192. The mandrel 194 is then pulledoutwardly, while the sleeve 190 is held in place, spreading the distalend 192 of the sleeve to lock the sleeve in place behind tissue 186. Theprotruding end of the mandrel 194 is then cut off flush with and bondedby heating as at 198 to the head end 200 of the sleeve. This type ofbonded connection can be used in various applications where the surgeonis connecting two tissue masses with access only from one side thereof.

The present invention also is embodied in a method of making an assemblyfor use in surgical applications in humans. The method comprises thesteps of providing a first component which comprises a heat bondablematerial; providing second component; and bonding the first and secondcomponents to each other by the application of heat to the heat bondablematerial to make the heat bondable material bond to the other component.In the method, the second component may be a surgical prosthesis orimplant, or it may be a bone plate or bone screw. The heat bondablematerial used in the method may be a polymer, a composite, or abiodegradable material.

The present invention also is embodied in a method of fastening a sutureor K-wire to hold together adjoining tissue masses in a human surgicalapplication. The method comprises the steps of inserting the suture intothe desired location in the tissue masses, placing in position on thesuture a suture fastener, and bonding the suture to the fastener byapplying heat to one or both of the fastener and the suture to bond thefastener to the suture. Further, the fastener may be mechanicallycrimped first and then heat bonded to provide the benefits of both typeof fastenings.

The present invention is also embodied in a kit of components forforming an assembly by heat bonding for use in surgical applications inhumans and incorporating at least one heat bondable material. The kitcomprises a first component and a second component comprising a heatbondable material, with the first and second components bondable to eachother upon the application of heat to the second component to make theheat bondable material of the second component bond to the firstcomponent. The kit may further include heat generating means forgenerating heat to bond said first component to said second component.The components and the heat generating means are as described above withrespect to the assemblies.

From the above description of the invention, those skilled in the artwill perceive improvements, changes and modifications. Suchimprovements, changes and modifications within the skill of the art areintended to be covered by the appended claims.

I claim:
 1. A method of permanently modifying the shape of a prostheticimplant for a person, comprising the steps of:providing a body ofbiocompatible heat bondable material having a desired predeterminedshape; heating a surface portion of the body to make the surface portiontacky for adhering to the implant, without heating the body enough tosubstantially alter the overall shape of the body; and then placing thetacky surface portion in abutting engagement with the implant to adherethe body to the implant.
 2. A method as defined in claim 1 furthercomprising the step of implanting the prosthetic implant when the bodyof material adhered to the implant is in a cooled state.
 3. A method asdefined in claim 1 further comprising the step of implanting the joinedbody and implant in the person after adhering the body to the implant.4. A method as defined in claim 1 further comprising the step ofimplanting the implant in the person prior to adhering the body to theimplant.
 5. A method as defined in claim 1 wherein said heating stepcomprises the step of heating with a laser.
 6. A method as defined inclaim 1 wherein said material is a composite material including anon-biodegrable resin matrix having a plurality of strengthening fibersembedded therein, said resin component becoming tacky upon heating.
 7. Amethod as defined in claim 6 wherein said resin is a polymer.
 8. Amethod as defined in claim 7 wherein said polymer is polyethylene.
 9. Amethod as defined in claim 1 wherein said material is a polymericmaterial.
 10. A method as defined in claim 1 further comprising the stepof adding an antibiotic material to the heated surface potion of thebody prior to adhering the body to the implant.
 11. A method as definedin claim 1 further comprising the step of adding a bone-ingrowthmaterial to the heated surface portion of the body prior to adhering thebody to the implant.
 12. A method of permanently modifying the shape ofa prosthetic implant for a person, comprising the steps of:providing abody of biocompatible heat bondable material having a desiredpredetermined shape; placing a surface portion of the body in abuttingengagement with the implant; and then heating at least one surfaceportion of the body adjacent to the implant to make the surface portiontacky to adhere the body to the implant, without heating the body enoughto substantially after the overall shape of the body.
 13. A method asdefined in claim 12 further comprising the step of implanting theprosthetic implant when the body of material adhered to the implant isin a cooled state.
 14. A method as defined in claim 12 furthercomprising the step of implanting the joined body and implant in theperson after adhering the body to the implant.
 15. A method as definedin claim 12 further comprising the step of implanting the implant in theperson prior to adhering the body to the implant.
 16. A method asdefined in claim 12 wherein said heating step comprises the step ofheating with a laser.
 17. A method as defined in claim 12 wherein saidmaterial is a composite material including a non-biodegradable resinmatrix having a plurality of strengthening fibers embedded therein, saidresin component becoming tacky upon heating.
 18. A method as defined inclaim 17 wherein said resin is a polymer.
 19. A method as defined inclaim 18 wherein said polymer is polyethylene.
 20. A method as definedin claim 12 wherein said material is a polymeric material.